Background : Pancreatic pseudocysts are complications of acute or chronic pancreatitis. The size of the pseudocyst and the length of time the cyst has been present are poor predictors for the potential of pseudocyst resolusion or complications, but in general, larger cysts are more likely to be symptomatic or cause complications.
Case Illustration: A young female was admitted to the hospital because of bloating after meal and recurrent epigastric pain. The patient could not eat normally because she felt of fullness after meal and painful sensation.Two months before admission the patient had the same symptom and was hospitalized for a week and diagnosed as a gastritis and cholecystitis.She readmitted was performed of US and revealed a very big mass and performed abdominal CT and showed a very big cyst a big cyst sized 19 cm x 10 cm x 10 cm. Because of the mass effect, we drained the fluid from the cyst and the culture showed S. aureus and CA 19-9 was 85 U/ml.
Discussion : Pseudocyst of the pancreas is a localized fluid collection that is rich in pancreatic enzymes and is surrounded by a wall of fibrous tissue that is not lined by epithelium. The etiology are pancreatic ductal pressure, either due to stenosis, calculi or protein plugs obstructing the main pancreatic ductal system, or as a result of pancreatic necrosis following an attack of acute pancreatitis. The incidence is low, 1,6%-4.5% of cases.Percutaneous drainage, endoscopic and surgical management must be performed to reduce and remove the cyst. There were no differences in complications (20%vs,21%) or pseudocyst resolution (93.3%vs.87.5%.P=0,39)between the surgical and endoscopic groups. Endoscopic ultrasound (EUS) is also capable of guiding the drainage of infected pseudocysts using naso-cystic drains. It may even be possible to drain infected necrotic pancreatic tissue using EUS and endoscopic techniques. |